Autoimmune Hepatitis: Causes, Risk Factors, Symptoms, Types, Diagnosis, Treatment, Complications and Prognosis

The liver helps the digestive system and carries out many other essential functions.

Autoimmune hepatitis is a type of liver inflammation in which the body’s immune cells attack healthy liver cells after mistaking them for foreign substances that cause disease.

It affects children and adults at any age. It is often diagnosed in people who have previously been diagnosed with a different autoimmune disorder.

These functions include the production of bile to help break down food into energy, create essential substances such as hormones, cleanse toxins from the blood, including those of medicines, alcohol, and drugs, and control the storage of fat and the production and release of cholesterol.

Causes of autoimmune hepatitis

Autoimmune hepatitis is a disease that affects two body systems, the liver, which is part of your gastrointestinal system, and your immune system.

While bacteria or viruses cause other forms of hepatitis, in autoimmune hepatitis, the immune system attacks liver cells because it cannot distinguish between harmful invaders and healthy liver tissue.

The body turns against itself is not clear. Still, researchers believe that autoimmune hepatitis could be due to an interaction between several risk factors, such as infections, medications, and a genetic predisposition.


Risk factor’s

Female gender

Although both sexes can develop autoimmune hepatitis, it is more common in female patients.


Type 1 autoimmune hepatitis can occur at any age. Type 2 mainly affects young women.

A history of certain infections

Autoimmune hepatitis can develop after a bacterial or viral infection.

Use of certain medications

Certain medications, such as the antibiotic minocycline (Dynacin, Minocin, and others) and the cholesterol drug atorvastatin (Lipitor), have been linked to autoimmune hepatitis.


Evidence suggests that a predisposition to autoimmune hepatitis can run in families.

Having an autoimmune disease

People who already have an autoimmune disease may be more likely to develop autoimmune hepatitis.


  • Fatigue.
  • Gastrointestinal upset.
  • Joint pains
  • A buildup of bile causes itching.
  • Jaundice (skin and sclera of the eye).
  • An enlarged liver ( hepatomegaly ).
  • Abnormal blood vessels in the skin (spider angiomas).
  • Nausea and vomiting
  • Loss of appetite
  • Skin rash.
  • Dark-colored urine.
  • In women, loss of menstruation.
  • Light-colored stools

Types of autoimmune hepatitis

There are two types of AIH based on serum tests:

  • Type I: is more common, tends to affect young women and is associated with other autoimmune diseases.
  • Type II:  mainly affects girls between the ages of 2 and 14. Although it usually occurs in adolescence or early adulthood, this disease can develop at any age.

Diagnosis of autoimmune hepatitis

Autoimmune hepatitis can easily be confused with other diseases. The symptoms are very similar to those of viral hepatitis.

To make a proper diagnosis, blood tests are required to:

  • Discard viral hepatitis.
  • Determine the type of autoimmune hepatitis.
  • Check liver function.

Blood tests are also used to measure specific antibodies in the blood. Antibodies associated with autoimmune hepatitis include:

  • Anti-smooth muscle antibody.
  • Anti-liver kidney microsome type I antibody.
  • Antinuclear antibody.

Blood tests can also measure the amount of immunoglobulin G (IgG) antibodies in your blood. IgG antibodies help the body fight infection and inflammation.

A liver biopsy may sometimes be necessary to diagnose autoimmune hepatitis. It can reveal the type and severity of your liver damage and inflammation.


Treatment can slow, stop, and sometimes reverse liver damage.

About 65 to 80 percent of people with autoimmune hepatitis will go into remission. However, the referral can take up to three years.

Immunosuppressive drugs

Immunosuppressive medications can be used to stop the immune system from attacking.

These drugs include 6-mercaptopurine and azathioprine. Taking immunosuppressive medications can compromise the body’s ability to fight other infections.


Corticosteroids, usually in the form of prednisone, can directly treat inflammation of the liver.

They can also serve as immunosuppressants. You will likely need to take prednisone for 18 to 24 months.

Some people must continue to take the drug for life to prevent autoimmune hepatitis from recurring.

At first, your doctor will likely suggest treatment with prednisone, a steroid that reduces inflammation.

They can start with a high dose, then lower it and add azathioprine (Imuran) or 6-mercaptopurine (Purinethol), which slows down the immune system.

Both drugs can have side effects. Prednisone can cause serious side effects, such as:

  • Development of diabetes.
  • Cause eye problems.
  • Weaken the bones causing osteoporosis.
  • Cause an increase in blood pressure.
  • Make the person gain weight.

Azathioprine and 6-mercaptopurine can lower the number of white blood cells and increase your chances of getting cancer.

Sometimes doctors recommend using steroid-like budesonide instead of prednisone. Your doctor may suggest other medications, such as mycophenolate mofetil, to suppress the immune system instead of azathioprine.

After three years of treatment, 80% of people find that their disease is under control.

Treatment may be stopped if the doctor thinks so. If symptoms return, treatment should be started again.

There are also lifestyle changes that can help you stay healthy. Eat healthy foods, detoxify fruits, and vegetables, and stay away from alcohol.

Liver transplant

Sometimes if you have cirrhosis or liver failure, you may need a liver transplant. This is surgery to remove the diseased liver and replace it with a healthy one from a donor.

However, the disease can sometimes come back even after a transplant. There is a one-year survival rate of 86 percent for people who have a transplant.


Autoimmune hepatitis can be associated with a variety of other autoimmune diseases, including:

Pernicious anemia

Associated with several autoimmune disorders, pernicious anemia occurs when there is a decrease in vitamin B-12 levels, which interferes with the body’s ability to form red blood cells.

hemolytic anemia

In this type of anemia, the immune system attacks and destroys red blood cells faster than the bone marrow can replace them.

Ulcerative colitis

This inflammatory bowel disease can cause severe bouts of watery or bloody diarrhea and abdominal pain.

Autoimmune thyroiditis (Hashimoto’s thyroiditis)

In this condition, the immune system attacks the thyroid gland.

Rheumatoid arthritis

Rheumatoid arthritis occurs when the immune system attacks the lining of your joints, causing stiffness, pain, swelling, and sometimes, deformity and disability.

Celiac Disease

This disease causes an abnormal reaction to gluten, a protein found in many grains.

Gluten consumption in these patients elicits an immune response that can damage the small intestine.

When untreated autoimmune hepatitis can cause liver cirrhosis.

Complications of cirrhosis cause an increase in blood pressure in the portal vein, which is the vein where blood from the intestine, spleen, and pancreas enters the liver.

If scar tissue blocks average circulation through your liver, this blood pools, increasing pressure within the portal vein (portal hypertension).

This causes esophageal varices, and they are likely to bleed. If the bleeding is massive, it can be fatal.

Liver disease can cause large amounts of fluid to collect in the abdomen (ascites).

Liver failure is the ultimate complication of autoimmune hepatitis; at this point, a liver transplant is the only option.

Patients with autoimmune hepatitis may have chronic liver inflammation and are at increased risk of developing liver cancer.

Prognosis of autoimmune hepatitis

The prognosis for autoimmune hepatitis is highly variable.

In many people, corticosteroid therapy is effective in slowing or even stopping the progress of the disease.

In other cases, autoimmune hepatitis can develop into liver cirrhosis, in which liver cells are replaced with scar tissue.

Cirrhosis causes permanent liver dysfunction and may require a liver transplant as the only treatment.